 Reorganization Lowers Vacancy and
Turnover Rates at Washington County
In one of the few industries in the nation where positions
outnumber applicants, health care managers have to sell their organizations
Donald Trump-style. With little of the glitz and glamour of casinos and hotels,
hospitals need managers with tremendous creativity to attract and keep a corps
of experienced staffers.
Enter Mary Towe, RN, MBA, executive for nursing services at
Washington County Hospital in Hagerstown-the brainchild behind a massive
organizational overhaul that has decreased her hospital turnover and vacancy
rates by almost 40 percent and 60 percent, respectively, over the last three
years.
Washington County's results may be a sign that things are
improving in the arena of hospital retention. Vacancy rates for RNs in Maryland
declined to 10.8 percent in 2003, down from 12.6 percent in 2002, and a
historic high in 2001 of 15.6 percent, according to the Maryland Hospital
Association Annual Personnel Survey.
"The needs of our staff weren't being met, and we knew we
had to change that," said Towe, who, along with the human resources department,
the nursing executive and the Advisory Board, and the senior administration
four years ago helped sculpt a three-tiered solution to a constant exodus of
nurses and allied health professionals.
First, Towe went straight to the source.
When she asked nurses why they were leaving, they often
cited poor relationships with their managers.
"Nurses told us that the managers were not available to them
and weren't acting as their advocates," Towe said, noting that the management
team was spread too thin, with some managers covering multiple patient units
and weighed down by paperwork. "The new nurses were missing out on the valuable
day-to-day instruction that a manager should be there to provide," she
said.
As a solution, the 300 bed community hospital created the
position of Clinical Director charged with planning operations, financial,
budget - freeing up the nurse managers to spend more time with their staff. The
hospital also hired more secondary assistants to help with creating time cards,
performance appraisals and other clerical duties. In order to retain new nurses
and give them the training they need, the hospital hired a nurse educator who
worked only nights and evening shifts when a lot of the newer nurses were on
duty.
Clinical Manager Veffa Devers, BSN, CCRN, has worked at
Washington County since 1999, overseeing an 86-member staff medical unit.
Previously serving as her own secretary, she had piles of work on top of her
daily management routines. "I was on my unit, but I was in my office a lot,"
said Devers. "I would spend hours filing things, but now I'm out there on the
floor."
After restructuring the management, Towe and the team looked
toward incentivizing the staff.
Nurses and nursing assistants said they were unhappy working
weekend, night, and evening shifts, so the hospital created significant pay
differentials to reduce the shift rotation of the staff. Now, hospital staff
get a 15 percent pay differential for working a weekend day, 20 percent for
working an evening and night, and 30 percent for working a weekend evening and
night.
"We wanted to make those shifts more attractive in an effort
to hire staff who really wanted those shifts and would work there permanently,"
said Towe.
Lastly, Towe rewrote the job description for the management
staff.
"Overall, the most important thing for us is to keep the
staff that we have and avoid backfilling with new staff," said Towe. Every time
the hospital lost a staff member it cost the organization $60,000-$70,000 in
lost productivity, overtime, and new hiring orientation fees, she said.
To remedy the situation, management job performance
evaluations are weighed on their ability to retain qualified staff.
"This was a huge shift in the department - the managers
needed to be creative," Towe said.
Now, nurse managers are required to list yearly those staff
members they deem most at risk to leave. Managers also take it upon themselves
to discuss personal ambitions, goals, and professional issues with their staffs
of nurses, nursing assistants and unit secretaries.
"We usually note people with ongoing attendance problems as
the most at risk," said Judy Abrams, RN, a medical surgical clinical manager.
If a staff member's needs aren't being met in their
department, a manager assists the staff member in relocating to another unit,
which may be better suited for the individual.
"We reward our managers for helping staff pursue their
professional goals within the organization," said Towe.
Devers lost only two nurses from her team last year by
helping them advance their roles to a different department. The
medical-surgical unit is often a growing-ground for nurses who then wish to
advance in other areas.
"If their goal is to stay on med surg great, if their goal
is to be a critical care nurse, great, it's our job to work with them to meet
their goals," said Devers. We want them to advance their careers and also keep
them in house."
Although the changes are rather new, the hospital has seen
substantial results.
In fiscal year 2002, the hospital's RN turnover rate was
10.2 percent, in 2003, 9.8 percent, and in 2004 it was down to 6.6 percent. The
hospital's RN vacancy rate was about 8-9 percent prior to 2003 and has
stabilized between 2.5 and 3 percent in fiscal year 2004, according to Towe.
Aside from the numbers, the overall satisfaction of nurses
is at an all-time high.
"We're committed to our staff; hopefully this trend will
continue," she said.
Contact:
Mary Towe, RN, MBA
Executive for
Nursing Services
Washington County Hospital
(301) 790-8215
towem@wchsys.org (Back to the top)
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